Getting Drunk on Pasta, Dizzy from Juice: Rare Diseases Uncover Misunderstandings and Prejudices

Getting drunk without drinking alcohol. When people hear such a story, many would first be skeptical. They might think it's just an excuse, that the person drank secretly, or that it's an urban legend seen online. However, in reality, a condition called "Auto-Brewery Syndrome (Gut Fermentation Syndrome)" has been reported, where microorganisms in the gut ferment ingested carbohydrates, producing ethanol within the body. The expression that a person's body becomes like a "brewery" is indeed shocking, but for those affected, it's not a strange anecdote but a serious issue that can ruin their life and credibility.

The difficulty of this disease lies in the fact that its symptoms appear too much like "just drinking alcohol." Medical reports describe a 50-year-old woman who visited the emergency room seven times over two years, repeatedly experiencing slurred speech, smelling of alcohol, and extreme drowsiness leading to collapse. She denied drinking, and her family supported this, yet she was treated as alcohol intoxicated in the emergency room and even underwent psychiatric and addiction-related evaluations. At one point, she was suspected of self-neglect and received measures under mental health law. In other words, she bore the dual burden of suffering from the disease itself and being treated as someone "lying."

Why does such a thing happen? The mechanism is surprisingly simple. Yeasts and some bacteria in the gut ferment carbohydrates found in bread, pasta, fruit juice, and sweets, producing alcohol. Normally, the ethanol produced in the body is in such small amounts that it doesn't cause problems, but if the balance of the gut environment is disrupted or if fermentation-prone microorganisms proliferate excessively, blood alcohol concentration can reach intoxicating levels. Repeated use of antibiotics, high-carbohydrate diets, abnormalities in carbohydrate metabolism, gastrointestinal dysfunction, and liver metabolism issues are thought to be involved.

In the case of the aforementioned woman, it was recorded that she frequently used ciprofloxacin and nitrofurantoin for recurrent urinary tract infections. Doctors considered that such antibiotic use and the intake of gastric acid suppressants might have disrupted her gut microbiota, laying the groundwork for the condition. In fact, when she started antifungal medication like fluconazole and a low-carbohydrate diet, her symptoms subsided, flared up again after increasing carbohydrates, and improved with treatment once more. Subsequent oral glucose tolerance tests did not detect alcohol, suggesting the treatment approach was effective. Despite the flashy disease name, the core of the treatment is grounded in "restoring gut health, suppressing causative microorganisms, and adjusting carbohydrate intake."

However, this disease cannot be dismissed as "rare and interesting." The Cleveland Clinic notes that while the recorded number of cases is fewer than 100, the low awareness may lead to it being overlooked. A systematic review in 2021 found only 17 case reports and 20 patients documented in the literature. Conversely, the rarity of cases makes it difficult for doctors to gain experience, and patients are easily dismissed with "there's no such disease." This is common with rare diseases, but here, the suspicion directly connects to social labels like "drinking," "addiction," and "lack of self-control," causing significant damage.

The difficulty in diagnosis lies in the need for procedures to prove it, despite the flamboyant symptoms. While supplementing the absence of drinking with family testimony, blood or breath alcohol concentration is measured, and reproducibility is confirmed with glucose loading. Stool tests, cultures, and endoscopic sampling are also conducted as needed. Thus, it's not a matter of belief but should be pursued with objective testing. The real challenge is that before reaching the testing stage, patients are often dismissed with "you must have been drinking."

When this topic spreads on social media, reactions are neatly divided into two. One is a half-joking tone of "body beer factory" or "dream constitution." The other is strong skepticism, wondering if it could be used as an excuse for drunk driving. In fact, in Belgium in 2024, a man confirmed to have this syndrome was acquitted of drunk driving, which became a global topic and was easily consumed as a "get-out-of-jail-free card" on social media. However, this case was judged by the court after three doctors independently confirmed the diagnosis, making it different from a mere spur-of-the-moment excuse. The internet rapidly spreads extreme cases, often omitting the weight and rigor of the diagnosis behind them.

What's even more interesting is that on social media, not only jokes and doubts exist, but also the earnest voices of those affected. On medical Reddit, while there are voices of healthcare professionals doubting it as "a new trendy disease to escape DUI," there are also posts from individuals or families claiming, "My life is ruined," "I get slightly drunk every day," "It's hard not being believed by doctors," and "My husband looks like he's been binge drinking for days just by eating carbohydrates." It's a structure where the cries of those truly in trouble are mixed in with the internet's typical pranks. When a rare disease becomes a topic, we tend to react with a binary of "true or false," but in reality, "a disease name that can be misused" and "a real disease that erodes lives" can coexist.

The true fear of this syndrome may lie not in the alcohol being produced in the body itself, but in how society perceives it. The individual, despite not drinking, is doubted by family, loses credibility at work, is treated as having an addiction in medical facilities, and may even face legal troubles. Systematic reviews emphasize that this condition carries social and legal consequences. Precisely because there are few case reports, each one is easily dismissed as "that can't possibly happen." Yet, the history of medicine has always expanded through the accumulation of initially doubted cases.

Getting drunk without drinking—due to its bizarre nature, this disease will likely go viral many times in the future. However, each time it goes viral, what's needed is not just surprise or jokes. When encountering unbelievable symptoms, the question is whether we can refrain from laughing them off or jumping to conclusions without criticism, and instead verify through testing and observation. A society that consumes rare diseases as "topics" is less preferable than one that first considers, "maybe there's someone truly in need of help."

Source URL

・InfoMoney
https://www.infomoney.com.br/ultimas-noticias/

・Case report of a 50-year-old woman (detailed case of seven emergency visits, improvement with antifungal medication and low-carbohydrate diet)
https://pmc.ncbi.nlm.nih.gov/articles/PMC11142034/

・CMAJ-related release summarizing key points of the above case report
https://www.eurekalert.org/news-releases/1046202

・Basic explanation of Auto-Brewery Syndrome (symptoms, causes, tests, treatment, risk factors)
https://my.clevelandclinic.org/health/diseases/auto-brewery-syndrome

・Systematic review (17 case reports, 20 patients organized as of 2021)
https://pmc.ncbi.nlm.nih.gov/articles/PMC8259373/

・Comprehensive review for medical education (organization of pathology, diagnosis, management)
https://www.ncbi.nlm.nih.gov/books/NBK513346/

・Report on acquittal of drunk driving in Belgium (background of legal points and social reactions)
https://www.reuters.com/world/europe/belgian-acquitted-drunk-driving-because-his-body-creates-alcohol-2024-04-22/

・Supplementary report on the above Belgian case
https://www.theguardian.com/world/2024/apr/22/belgian-man-whose-body-makes-its-own-alcohol-cleared-of-drunk-driving

・One of the sources of SNS reactions (thread on Reddit with mixed skepticism, jokes, and earnest voices of those affected)
https://www.reddit.com/r/medicine/comments/1cbhl1c/